Conquering real anxiety through virtual reality

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders with fear of flying in San Francisco, Calif., on Tuesday, July 21, 2015.

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology to help treat patient anxiety disorders with fear of flying in San Francisco, Calif., on Tuesday, July 21, 2015.

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology in a 3D viewer to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology in a 3D viewer to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology with a 3D viewer to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Clinical psychologist Elizabeth McMahon, Ph.D, shows her use of Psious virtual reality technology with a 3D viewer to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015.

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows the video images used in a 3D viewer for Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, July 21, 2015. The video shown is used to treat patients with fear of public speaking. less

Clinical psychologist Elizabeth McMahon, Ph.D, shows the video images used in a 3D viewer for Psious virtual reality technology to help treat patient anxiety disorders in San Francisco, Calif., on Tuesday, ... more

Photo: Liz Hafalia, Staff

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Clinical psychologist Elizabeth McMahon, Ph.D, shows how Psious technology has a chart where anxiety levels can be recorded on patients viewing virtual reality situations such as this nurse withdrawing blood in San Francisco, Calif., on Tuesday, July 21, 2015. less

Clinical psychologist Elizabeth McMahon, Ph.D, shows how Psious technology has a chart where anxiety levels can be recorded on patients viewing virtual reality situations such as this nurse withdrawing blood ... more

Photo: Liz Hafalia, Staff

Conquering real anxiety through virtual reality

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Dozens of people sit in rapt attention, hands folded in their laps, staring right at you. Your heart races and your palms sweat as the audience awaits your speech.

Thanks to advances in virtual reality technology, those who fear public speaking - an anxiety shared by a quarter of Americans surveyed in a Chapman University poll - can now confront their fears in a simulated world.

For years, virtual reality has been considered a potential treatment for mental health disorders due to its ability to immerse patients in realistic situations, helping to treat conditions such as post-traumatic stress disorder, anxiety, alcohol dependence and pain. But until recently, virtual reality graphics were rudimentary and headsets were pricey.

"It's been researched for more than 20 years ... but the systems have been so expensive that they've been limited to specific uses, like research or the military," said Scott Lowe, the general manager at Psious, a San Francisco and Barcelona startup that makes virtual reality scenarios to help patients face such fears as flying, heights, needles, public speaking, driving and insects. "The revolution is in the mobile technology, which allows us to do it cheaply, using technology (smartphones) that's already distributed in your hands."

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Now, with big players like Facebook, Samsung and Google getting into virtual reality, and headsets available for $200 or less, it's within the reach of more psychologists and their patients.

Elizabeth McMahon, a San Francisco psychologist, said that using virtual reality to treat anxiety often helps her patients progress faster.

She and other psychologists using virtual reality for anxiety-related conditions add technology to traditional exposure therapy, which is commonly used to treat phobias and post-traumatic stress disorder. Instead of patients simply talking through a traumatic situation, virtual reality allows them to safely encounter scenarios that trouble them. The idea is to teach the brain to stop sending fear signals when there's no actual threat.

"The brain only has one response to threat, whether it's real or imagined," McMahon said. When a person's anxiety is triggered, "All of a sudden our body's telling us we're in danger, our emotions are telling us we're in danger and our mind is telling us we're in danger."

In her office, McMahon uses her computer and Psious software to control what patients see on a virtual reality headset. Normally, patients who are afraid to fly can't drag their therapists onto planes to coach them through takeoff, flight and landing.

Virtual reality "bridges that gap between talking in the office or imagining it and being out on your in own in real life with your therapist," she said.

While a virtual reality flight is not completely lifelike, McMahon can control the weather and other aspects of the experience, and patients can turn their head to see the seats next to them. She said patients are surprised at how effectively it triggers their fears - causing them to clench the arms of their chair or step away from a simulated precipice.

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Treating anxiety isn't the only therapeutic use for virtual reality. It has been used to reduce burn patients' pain by showing them visualizations of snowy climes. It may also be effective in treating people with alcohol dependence, according to a study published in June in the Journal of Studies on Alcohol and Drugs,√ which exposed patients to virtual drinking situations.

Studies have also found virtual reality exposure therapy to be as or more effective than regular exposure therapy for treating PTSD, said Skip Rizzo, the director for medical virtual reality at the University of Southern California's Institute for Creative Technologies. PTSD affects nearly a third of Vietnam War veterans, 11 percent of those who fought in Afghanistan and 20 percent from the Iraq War.

For veterans who have it, an everyday action or event - like watching fireworks - can trigger a traumatic experience.

"The trauma initially is a normal reaction: You see your best friend get their head blown off, feeling bad and being uptight and depressed and all that negative stuff, that's normal," Rizzo said. "The problem is when it doesn't go away ... it actually gets worse. It generalizes to safe places."

In his lab at USC, Rizzo and his colleagues make virtual reality scenarios designed to help returning veterans. In therapy, the veteran dons a virtual reality headset to revisit a scenario in which he or she had a traumatic experience.

"If one of the things that really bothers you is your experience in an Iraq village, it won't be exact, but pretty close," Rizzo said. With his scenarios, therapists can adjust the time of day, whether the town square is crowded or empty, and whether the soldier is walking alone. The therapist can add vibrations, smells and sounds, like a baby crying or a call to prayer.

As in traditional exposure therapy, the therapist asks the soldier to narrate the events that caused the trauma, over and over, in greater and greater detail, teaching the amygdala - the part of the brain that controls the fight or flight instinct - to stop overreacting.

"You're never going to forget it, there's not a way of making it pretty, but it doesn't have to haunt you and be a life sentence of pain and anxiety," he said.